<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Day_register')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-day_register" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[day_register]" type="text" value="{:date('Y-m-d H:i:s')}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('App_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-app_id" data-rule="required" data-source="app/index" class="form-control selectpage" name="row[app_id]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Num')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-num" class="form-control" name="row[num]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Day2')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-day2" class="form-control" name="row[day2]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Day3')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-day3" class="form-control" name="row[day3]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Day4')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-day4" class="form-control" name="row[day4]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Day5')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-day5" class="form-control" name="row[day5]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Day6')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-day6" class="form-control" name="row[day6]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Day7')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-day7" class="form-control" name="row[day7]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Day15')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-day15" class="form-control" name="row[day15]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Day30')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-day30" class="form-control" name="row[day30]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Day60')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-day60" class="form-control" name="row[day60]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Day90')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-day90" class="form-control" name="row[day90]" type="number">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
